Student Enrollment Form

Program Enroll

Program

Student Information

Student's Name

First name

Last name

Gender

Birthday

Month

Day

Year

School

Grade

Home Address

Multi-line address

Country/Region

Address

City

Zip / Postal code

Parent/ Guardian Information

First Name

Last Name

Cell Phone

Home Phone

Emergency Information

(Please provide emergency contact information for someone other than the person listed in the parent/guardian field.)

First Name

Last Name

Relationship

Phone

Medical Information

Does the child have any congenital, developmental abnormalities, allergies, chronic illness, or medical conditions? If YES, please describe.

Is the child prescribed an inhaler? If YES, please explain any instructions.

Media/Photo Release Form

I hereby give permission for my child to be photographed or videotaped during Menlo Chinese School activities and for my child’s photo and/or image to be used in Menlo Chinese School publications and promotional materials.

Yes

Agreements and Consent

Liability Waiver/ Medical Release

I, the undersigned, am the parent and/or legal guardian of the student noted on this document, and hereby fully release and discharge Menlo Chinese School, their officers, employees, agents, servants, and volunteers from any and all liability arising in connection with the above described independent activities and all liabilities associated with any and all claims related to such activity that may be filed on behalf or for the above named minor.

For the purpose of this release, “liability” means all claims, demands, losses, causes of actions, suits or judgments of any and every kind that arise as a result of the above described activity and resulting from any cause.

By agreeing below, I give permission for my child to participate in all Menlo Chinese School programs.

I also give my consent to any medical treatment deemed necessary by medical personnel for the physical well-being of my child. I assume full responsibility for my child’s behavior and agree to pay for all damages to property or person caused by him/her.

I understand that I will be notified if my child’s behavior interferes with any activity, and that further disciplinary problems may result in his/her expulsion from Menlo Chinese School.

This release and waiver shall remain in effect while my child is a student at Menlo Chinese School.

I understand that I may revoke my consent in writing. However, if I do so, my child will no longer be permitted to participate in any Menlo Chinese School programs.

I understand that this release and waiver is intended to be as broad and inclusive as permitted by the laws of the State of California, and agree that if any portion is held invalid, the remainder of this release and waiver will continue in full force and effect.

I acknowledge that I have had sufficient time to read this entire form. I have carefully read and understand all of it and I agree to be bound by its terms.

I agree.

Financial Responsibility Agreement

I understand and agree to accept financial responsibility for the payment of the invoice submitted by Menlo Chinese School.

I understand and agree it is my responsibility to keep my account paid up to date and that failure to keep my account current may result in my child(ren) being denied access to the Menlo Chinese School Program and my account being sent to collection.

In addition, I have read the Menlo Chinese School Billing Policy included in this registration form, and agree to accept all terms and conditions as outlined in these items.

I understand the Menlo Chinese School Registration Form and Emergency Card(s) must be on file with Menlo Chinese School prior to my child(ren) attending Menlo Chinese School.

I further understand and agree that my failure to comply with the policies and procedures will result in either denial of this application or loss of privileges for my child(ren) to attend Menlo Chinese School.

I agree.

Arbitration Agreement

Any action involving Parent/Guardian/Student and Menlo Chinese School arising out of the relationship between the parties must be arbitrated with binding arbitration at AAA. The arbitration will be in Menlo Park, California. No discovery is permitted except for damages.

I agree.

Cancellation and Freeze Policy

Our afterschool program requires a one-year commitment, but you may freeze your participation at any time, with any refund issued as a credit for future use. To freeze or cancel your participation, a 30-day notice is required, and you will be charged for one final billing cycle after your notice is submitted. Please note that refunds will not be issued for unused classes or any billing that occurred prior to your cancellation or freeze request.

I agree.

If you cancel and wish to re-enroll in the future, you will need to set up a new membership at the prevailing rate, which may be higher than your current rate.

By signing and submitting this form, you verify that you understand the terms of cancellation and freezing. Your electronic submission will be reviewed by a Menlo Chinese School support member, and you will receive a confirmation email within approximately 72 hours. Please keep a copy of the confirmation email for your records.

I agree.

Acknowledgment and Signature

By signing below, I confirm that the information provided is accurate to the best of my knowledge. I understand and agree to the terms of this liability waiver and acknowledge that I have the legal authority to provide this consent.

Signature field is empty.

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